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Nominated Member Application
Select your type of
membership *
Select one
Full Member
Student
Retired
Corporate
Name of CAPHD member sponsoring your free membership *
Your Contact Information
First Name *
Last Name *
Street Address *
Unit Number
City *
Province/Jurisdiction *
Postal Code *
Telephone *
Email Address *
Member Profile
Employing Agency
Profession
Other memberships
CDA
CDHA
CDTA
CDAA
DAC
Other
None
If "other" above, describe
If a Corporate Membership:
Name of Corporation
If A Student Membership, Include:
School Attending
Program Name
Expected Completion
(month and year)
* = Input is required